Special Considerations for CPR, AED, & Choking

Many questions come in related to special considerations for performing CPR, using AEDs, and applying choking skills, so we decided to take the most common of the bunch and share them with you. Along with our recommendations of how to treat different types of patients in light of these considerations.

Special Considerations for CPR

The three most common concerns we hear when it comes to performing CPR are:

1. The size of the patient.
2. The crunching sound and feeling when performing chest compressions.
3. Impaled objects in the chest.

The Size of the Patient

This has more to do with the size discrepancy between rescuer and patient than the size of the patient alone. Sometimes, when performing chest compressions, a patient will require more weight than a rescuer can muster. If this happens, try to recruit a bystander to assist you while you guide them along.

Performing chest compressions isn't difficult, particularly if there's someone next to you telling you how to do them.

Crunching and Popping Sounds

These sound worse than they usually are. These sounds and crunching feelings could be related to a traumatic injury. But more likely, it's just due to the separation of cartilage from the sternum, which also sounds worse than it is. Think of it how you would cracking your knuckles. You're simply releasing air trapped inside cartilage.

Also keep in mind that you're not going to hurt the victim any more, as they are already dead.

Impaled Chest Objects

The only way an impaled object would keep you from performing chest compressions is if the object were in the exact location. If that's the case, all you can do is call 911, keep the scene safe, and do whatever you can do to control bleeding or other issues.

However, if you can, just work around the impaled object and perform compressions to the best of your ability.

This situation could also arise when it comes to giving rescue breaths, should the patient have an impaled object in the mouth, face, or airway.

Special Considerations for AEDs

It's important to understand that to get better use from an AED, you may have to understand and use a few workarounds. And when it comes to using AEDs, these are the four most common concerns we hear.

1. How to handle jewelry.
2. How to handle patches.
3. How to handle underwire bras.
4. How to handle breast tissue that's in the way.

Jewelry

As the types of jewelry changes over the years, questions concerning jewelry also change. When it comes to necklaces, these are easy to move out of the way; no need to take them off.

However, with piercings, location matters. If the piercing is directly where a pad would go, or if it appears like it would interfere with the pathway of the electricity, remove the piercing first. Otherwise, piercings shouldn't pose any problems.

Patches

Nitro patches, pain relief patches, and other types of medication patches come off easily. So, if a patch is resting where an AED patch should go, remove it, wipe the area so it's dry, and apply the pad as normal.

Underwire Bras

Unless you think the bra's wires will interfere with the pathway of electricity, like sending it any where other than where it should go, then remove the bra. Otherwise, you're probably OK using an AED with it in place.

Breast Tissue

If you encounter breast tissue where an AED pad should go – likely the mid auxiliary rib cage – simply move it and apply the pad.

Special Considerations for Choking

The three most common concerns we hear with choking incidents are:

1. What if the choking victim is too large?
2. What if the choking victim is pregnant?
3. What if the obstruction won't come out?

The Patient is Too Large

Again, we see where a discrepancy in size between rescuer and victim matters. If the victim you're trying to help is too large for you to get your arms around, enlist the help of a bystander, and like before, you can guide the bystander through the abdominal thrust technique.

Otherwise, if there are no bystanders and it's just you, consider using the inward thrusts directly on the sternum instead, just as you would a pregnant woman. Tuck in your thumb, go under the breast, and onto the sternum. Thrust inward, rather than up and inward like you would with abdominal thrusts.

The Patient is Pregnant

A pregnant patient is really two patients – one primary patient (mother) and one secondary patient (baby). If you suspect a conscious choking female adult to be pregnant, avoid performing abdominal thrusts, as these can injure the uterus or baby.

Instead, perform inward thrusts on the sternum as is described above.

The Obstruction Won't Come Out

This isn't common, but it's scary when it happens. And most of the time, it could have easily been avoided.

Certain gooey foods, like marshmallows, can act almost like glue if inhaled. Other items that pose unusual risks include mylar and latex. Coins are also particularly hazardous. If they are swallowed just right, they can act like a one-way valve in the larynx – one that opens with a compression and closes with a rescue breath.

In the event of emergencies like this, where difficult obstructions won't come out, EMS personnel also have special tools to assist them, such as suction equipment and forceps that can reach down the throat.